Mt. Mansfield. photo by Jared C. Benedict

Today’s opus will be presented as three un-related chapters, each with its own title, as follows:

1—Vermont the Healthy?

Among Vermont’s other distinctions, it seems to be Number One in health-consciousness.

In the latest Gallup-Healthways Well-Being Index, Vermont scored 69.1 on the “healthy behavior index score,” higher than it did last year and 1.3 clicks ahead of second-place Hawaii.

This does not prove that Vermonters are healthier than anyone else. In fact it doesn’t prove anything; it’s survey research, which provides indications, not incontrovertible fact.

The indications are that Vermonters take care of themselves better than other Americans. They are less likely to smoke, more likely to exercise, most likely to eat lots of fruits and vegetables.

That’s the good news. The not-so-good news is that being best in America does not necessarily men being very good. Overall, the survey found that the “nation as a whole (is) dropping substantively on the Healthy Behavior Sub-Index, from 63.7 in 2008 to 62.6 in the first half of 2009.” In fact, “Mississippi, whose score ranks among the bottom 10, is the only state to record a statistically significant increase in its healthy behavior score.”

So there’s little justification here for Vermonters getting a swelled head about their (relatively) good habits. To begin with, there doesn’t seem to be all that much specifically “Vermontish” in these results. Almost all the states in the Northeast scored reasonably well, as did the Rocky Mountain states and the West Coast (except Washington State and Nevada.). To some extent, then, being health-conscious is a regional habit.

And probably an educational habit. More than 35 percent of adult Vermonters graduated from college, more than in all but five other states. College graduates tend to be more health conscious, not to mention more affluent. Not only do they know that they ought to go to the gym, they can afford the membership.

On the other hand, Vermont is the most rural of the states in the top ten, and there is ample evidence (such as this 2005 study in Pennsylvania) that rural residents don’t have the healthiest habits. They are more likely to smoke, less likely to exercise, and they gobble up lots of fried foods.

Meaning that perhaps it is the residents of Chittenden County and a few others outposts who take good care of themselves. But the survey didn’t get down to the county or town level.

The Gallup survey says it provides “a daily measure of people’s well-being…based on the World Health Organization (WHO) definition of health as not only the absence of infirmity and disease but also a state of physical, mental and social well-being.”

Whereupon we segue, as the TV folks would say, into……

CHAPTER TWO: VERMONT THE GOOD?

One way lots of Vermonters stay healthy is by doing stuff outdoors. That’s not in the Gallup survey, but we know from many sources that people in this state are more likely than most other Americans to hike and camp out, to paddle a kayak or canoe, to work in their gardens or in the woods.

Now comes evidence that all this activity not only helps make a person healthier. It can him or her a better person – kinder, more generous, less selfish. Contact with nature, says a new study “brings individuals closer to others, whereas human-made environments orient goals toward more selfish or self-interested ends.”

A bit of skepticism is in order here. Psychology lacks the precision of physics. Studies such as this one – conducted by psychologists Netta Weinstein, Andrew K. Przybylski, and Richard M. Ryan – sometimes conclude with the conclusions the studiers wanted to find before they started.

But these folks have credentials – Weinstein is a clinical psychologist at the University of Rochester – and their findings sufficiently intrigued the editors at the interesting, lively, new Miller-McCune Magazine that they wrote about them in an article called “Immersion in Nature Makes us Nicer.”

Why would it? Writer Tom Jacobs reports that “Weinstein and her colleagues suggest the answer lies in an enhanced sense of personal autonomy. ‘Nature affords individuals the chance to follow their interests and reduces pressures, fears, introjects and social expectations,’ they write.

Introjects? A term the meaning of which seems to be in dispute but is related to making too big a deal of oneself.

If both un-confirmable and un-refutable, the notion does seem to make some sense. Not there aren’t some very nice couch potatoes and a few avid white-water paddlers who are real stinkos, but connecting with the natural world (and this includes spending time with your house plants)would seem to reduce stress, encourage a contemplative outlook, and keep one on an even keel (except, literally, in that kayak in white-water).

And speaking of even keels, we segue to….

CHAPTER THREE: ET TU JACOBE?

Did everybody note that even Gov. Jim Douglas would not come right out and say what he (almost surely) knows is true: that this business about “death panels” in the proposed health care legislation is some combination of dishonesty and insanity?

Asked about it at his press conference last week, the Governor, as reported by Terri Hallenbeck of the Burlington Free Press in the paper’s Vermont Buzz blog, would only note that the argument was “an example of the kind of rhetoric that’s distracting us from fundamental reform.”

“But he did not come out and denounce the death-panel debate nor would he say he felt confident the proposed legislation didn’t include death panels,” Hallenbeck wrote. “He said that like most members of Congress he had not read every word of the legislation.”

No condemnation here of Douglas, who was doing what he had to do. Oh, it would have been admirable for him to have said (in somewhat more diplomatic language), “this stuff is crazy.”

But that would have been dangerous, and what is interesting is why it would have been dangerous.

In the latest polling on the subjects (NBC News/Wall Street Journal), 45 percent of the respondents said they thought the health care proposals before Congress “Will allow the government to make decisions about when to stop providing medical care to the elderly.”

Those proposals will allow no such thing.

Checking the polls’ “internals, “ it’s reasonable to conclude that the percentage in Vermont is smaller, probably closer to a third, roughly the percentage of Vermonters who voted for John McCain last year.

In other words, that third is Douglas’s base. A politician can not afford to tell his base that they are (not to put too fine a point on it and using the term in its colloquial rather than its clinical context) out of their minds.

Or, more gently, that they have allowed themselves to believe outright lies.

But maybe “allowed is less accurate than “affirmatively chosen” to believe outright lies, which leads to the question of why so many people would so choose.

A complicated question, perhaps pursued another time. Meanwhile ponder what it means that a sane and responsible governor fears to suggest that some of his constituents are acting in a manner neither sane nor responsible.

A majority of  the people of this state-no, make that a huge if not an immense, majority-favor raising taxes on either tobacco,  the very wealthy, or both, “in order to keep Catamount Health, Dr. Dynasaur and other state health care programs affordable for low income Vermonters.”

It’s in a poll. The poll was taken by Macro International of Burlington, a respected firm whose surveys have been used by businesses and advocacy groups in Vermont for years.

Here are the results: Seventy-seven percent of those surveyed would support a temporary state income tax surcharge on those earning more than $500,000 a year. Eighty-two percent would support raising the cigarette tax by a dollar to subsidize the health care programs.

That sounds impressive. Actually, it sounds unbelievable. It’s hard to get a 77 percent majority-much less 82 percent-for almost anything. Asking a random sample of people whether they approve of motherhood and apple pie would probably get more negative responses than these two questions did.

The questions  on the income tax surcharge the cigarette tax were inserted into a broader survey that Macro takes four times a year on behalf of various clients, according to Stephanie Ezzo, the company’s assistant research manager.

“I bought these two questions,” said Peter Sterling, the Executive Director
Vermont Campaign for Health Care Security.

Sterling bought them and wrote them. He is an advocate, not a pollster.

“It is not a neutral question,” Sterling acknowledged. “The question is worded in a way that elicits a greater understanding of the issue. I honestly say that because I don’t believe people think about their taxes going to specific programs. They think their taxes are going to some guy sitting behind a desk.”

The wording of the questions breaks one basic rule of polling-asking respondents only if they would support the higher taxes. A polling question should ask whether the respondents support (or favor)  or oppose. Presenting only the favorable option “leads the respondent by suggesting the position … of an authority with which it might be difficult for the respondent to disagree.”

That’s the fancy language  the American Association for Public Opinion Research (AAPOR) uses to explain that some respondents, when hearing only one option, tend to assume that it is the “correct’ or expected choice.

In addition, the questions linked the proposed tax hikes to Catamount Health and Dr. Dynasaur, two of the most popular programs in the state. Dr. Dyanasaur, which has provide health  coverage for low-income children for more than a decade, has acquired a reputation in the state close to that of…well, motherhood and apple pie. Catamount Health is much newer. But according to a poll taken for the state by Lake Research Associates a year ago, it is overwhelmingly popular.

Had the questions just asked about “health programs for low-income people”  without mentioning the popular Dr. Dyanasaur and Catamount Health “brands,” the results might have been different.

Furthermore, respondents can be influenced by the questions that came earlier in the survey. These are not being released. Stephanie Ezzo said she could not divulge the other questions in the survey, taken for other clients, mostly businesses. She would not even say whether any of the earlier questions had dealt with health care, poverty, or tobacco, subjects that could have altered the outlook of some respondents.

“Other clients can participate so (the survey) oftentimes jumps from subject matter to subject matter,” she said.

According to the AAPOR, earlier questions can set up a “context effect.”  For example, according to its web site, “if you ask questions about a specific issue like the economy before asking what the most important problem is facing the nation, respondents will be more likely to name the economy in that subsequent question then they would have been without having that context set up for them.

In that statement, the AAPOR was talking about deliberate distortion. That is not the case here. Neither Sterling, who said his organization paid $1,000 to get the two questions in the poll, nor Macro International is guilty of unethical conduct.  Sterling does not seem to have been trying to pull a fast one. He apparently did not know the basic rule about asking “support or oppose.”

Nor does there seem to be any reason to doubt Ezzo’s assertion that “everything we do is methodologically sound.”  Macro International is a reputable company, and “piggy-backing” questions into a larger poll seems to be standard practice in Vermont.

It’s just that the results aren’t really credible thanks to the flawed wording and the mystery about what questions may have preceded the two about tax hikes and health care.

From various polls it’s reasonable to assume that a majority of Vermonters-but not three quarters or 80 percent majorities — would in fact favor both those tax increases to keep the health care programs affordable for poor and low-income people. In neither case would the tax hikes violate the fabled wisdom of the late Sen. Russell Long of Louisiana, for years the chairman of the Senate Finance Committee. The typical American’s tax preference, Long said, was “Don’t tax you. Don’t tax me. Tax that fellow behind the tree.”

Most people in the state do not smoke, and only a tiny percentage earn close to $500,000 a year. Few, then, are that fellow behind the tree.

And clearly most Vermonters are pro-health care. That Lake Research Partners study found that a large majority agreed that “the state should help people get affordable health coverage if they cannot afford health coverage on their own or get it through a job.”

Still, Vermonters, like other Americans, retain a visceral distaste for higher taxes, even if they are not the ones being taxed. So the huge pro-tax margins in this poll seem…well, too huge.

But Sterling did at least try to find out whether voters would consider some selective tax increases to finance social programs. On the other side of the debate. Gov. Jim Douglas and his aides simply keep asserting that Vermonters are opposed to any and all tax hikes, making no attempt whatever at providing anything resembling evidence.